please write the answer and your justification, correct answer will be submitted after 48 hrs

 

[size=20px]A three-year old boy with no prior abdominal surgery is brought to the operating room for bowel obstruction. At surgery a left mesocolic hernia is found. The bowel can not be reduced from the hernia sac. The most appropriate maneuver with this child with intestinal obstruction is to

 

A mobilize the left colon along its lateral attachments.

 

B divide the inferior mesenteric vein.

 

C open the hernia sac.

 

D incise the colonic mesentery just to the right of the inferior mesenteric vein.

 

E divide Ladd’s bands.[/size]

Edited October 18, 20206 yr by Admin

C

D

A

correct answer:

 

D incise the colonic mesentery just to the right of the inferior mesenteric vein.

 

Mesocolic hernias are rare and result from anomalies in bowel rotation. They are also called paraduodenal hernias. Signs and symptoms of mesocolic hernia are those of bowel obstruction: intermittent crampy pain with progression to vomiting and persistent pain. While obstruction can be suspected or diagnosed with plain films or an upper gastrointestinal series, computerized tomography is the best way to diagnose a mesocolic hernia.

 

A right mesocolic hernia results when the prearterial limb of the midgut fails to rotate appropriately around the superior mesenteric artery. The key maneuver in resolving a right mesocolic hernia is mobilization of the right colon to reduce the hernia. This is followed by a Ladd procedure.

 

A left mesocolic hernia accounts for 50% of internal hernias in a previously nonoperated abdomen. It results when bowel is trapped in an unsupported area of descending mesocolon between the inferior mesenteric vein (IMV) and the left posterior colonic attachments. The key maneuver to reduce entrapped bowel is to incise the mesentery along the right side of the IMV. The defect can then be closed by attaching the mesentery to the posterior peritoneum.